THE HIDDEN PICTURE: UNHEALTHY EATING ATTITUDES AND BEHAVIORS IN A NON-CLINICAL POPULATION FROM BULGARIA
Abstract
INTRODUCTION: Eating disorders have been intensively researched over recent decades. However, there has been insufficient research into the early assessments for detecting the risk of developing disordered eating. We report preliminary results from a project aiming to assess the prevalence of eating attitudes and behaviors that heighten the risk of eating disorders. The study examines a non-clinical sample of adolescents and adults from two cities of South Bulgaria.
METHODS: In this cross-sectional epidemiological study, a total of 1285 volunteers of 828 females and 453 males, aged 14 to 59 years, were surveyed to assess disordered eating attitudes and behaviors. For this purpose, the study used the ‘SCOFF’ questionnaire, the Eating Disorder Diagnostic Scale (EDDS), and the Eating Attitudes and Behaviors Questionnaire (EABQ), which was developed for this study.
RESULTS: The proportion of these volunteers underweight (body mass index below 17.5) was 9.8%. Of the total subject, 34.7% provided two or more positive answers for the SCOFF questionnaire (two being the upper threshold for indicating 100% sensitivity to anorexia and bulimia). The results differed between males and females: 21.6% and 42.1%, respectively, in this regard. A factor analysis (oblimin rotation) of EABQ items revealed four main factors: body shape and weight concerns, personal control over eating and calorie intake, dieting, and preoccupation with food and binge eating. A Spearman’s correlation analysis showed moderately significant correlations (p < 0.001) between the total scores of the SCOFF questionnaire, EABQ, and the scores for three groups of items in the EDDS for assessing eating attitudes and behaviors.
CONCLUSION: We found a greater ED risk in adolescents compared with the older groups and in females compared with males. One fifth of males studied were at high risk of ED and ages between 19 and 39 years also appeared at risk. The EABQ was validated as a sensitive and reliable self-report instrument that can be used for early detection for the risk of ED. Our results could form a basis for developing programs in disordered eating prevention.References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). doi:10.1176/appi.books.9780890423349
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM- V. (5th ed.). Washington, DC: American Psychiatric Association.
Brown, J. (2009). Choosing the right type of rotation in PCA and EFA. JALT Testing & Evaluation SIG Newsletter, 13 (3), 20-25.
Bulik, C. M., Reba, L., Siega‐Riz, A. M., & Reichborn‐Kjennerud, T. (2005). Anorexia nervosa: definition, epidemiology, and cycle of risk. International Journal of Eating Disorders, 37(S1), S2-S9.
Cotrufo, P., Barretta, V., Monteleone, P., & Maj, M. (1998). Full‐syndrome, partial‐syndrome and subclinical eating disorders: an epidemiological study of female students in Southern Italy. Acta Psychiatrica Scandinavica, 98(2), 112-115. DOI: 10.1111/j.1600-0447.1998.tb10051.x
Garcia, F. D., Grigioni, S., Chelali, S., Meyrignac, G., Thibaut, F., & Dechelotte, P. (2010). Validation of the French version of SCOFF questionnaire for screening of eating disorders among adults. The World Journal of Biological Psychiatry, 11(7), 888-893.
Herpertz-Dahlmann, B. (2009). Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. Child and adolescent psychiatric clinics of North America, 18(1), 31-47.
Herzog, D. B., Norman, D. K., Gordon, C., & Pepose, M. (1984). Sexual conflict and eating disorders in 27 males. The American journal of psychiatry,141(8), 989-990.
King, M. B. (1990). Eating disorders in general practice. Journal of the Royal Society of Medicine, 83(4), 229–232.
Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders. British Medical Journal, 319(7223), 1467–1468.
Muro-Sans, P., Amador-Campos, J. A., & Morgan, J. F. (2007). The SCOFF-c: Psychometric properties of the Catalan version in a Spanish adolescent sample. Journal of psychosomatic research, 64, 81-86.
Pope, H. G., Katz, D. L., & Hudson, J. I. (1993). Anorexia nervosa and “reverse anorexia” among 108 male bodybuilders. Comprehensive psychiatry, 34(6), 406-409.
Sepulveda, A. R., Carrobles, J. A., & Gandarillas, A. M. (2008). Gender, school and academic year differences among Spanish university students at high-risk for developing an eating disorder: an epidemiologic study. BMC Public Health,8(1), 1. DOI: 10.1186/1471-2458-8-102
Shader, M. (Ed.) (1994). Manual of Psychiatric Therapeutics. Boston et al., Little, Brown and Co.
Smolak, L., Levine, M. P., & Striegel-Moore, R. H. (1996). The Developmental Psychopathology of Eating Disorders. Mahwah, Erlbaum. books.google.com
Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the Eating Disorder Diagnostic Scale: a brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological assessment, 12(2), 123.
Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. American Psychologist, 62(3), 181. DOI: 10.1037/0003-066X.62.3.18
Striegel-Moore, R. H., Silberstein, L. R., & Rodin, J. (1986). Toward an understanding of risk factors for bulimia. American psychologist, 41(3), 246
Thiel, A., Gottfried, H., & Hesse, F. W. (1993). Subclinical eating disorders in male athletes. Acta Psychiatrica Scandinavica, 88(4), 259-265.
Touchette, E., Henegar, A., Godart, N. T., Pryor, L., Falissard, B., Tremblay, R. E., & Côté, S. M. (2011). Subclinical eating disorders and their comorbidity with mood and anxiety disorders in adolescent girls. Psychiatry research, 185(1), 185-192.
Treasure, J., & Kordy, H. (1998). Evidence based care of eating disorders: beware the glitter of the randomised controlled trial. European Eating Disorders Review, 6(2), 85-95.
Whitehouse, A. M., Cooper, P. J., Vize, C. V., Hill, C., & Vogel, L. (1992). Prevalence of eating disorders in three Cambridge general practices: hidden and conspicuous morbidity. Br J Gen Pract, 42(355), 57-60.
World Health Organization (1990). ICD-10 International statistical classification of diseases and related health problems. Retrieved from http://www.who.int/classifications/icd/en/
Yannakoulia, M., Matalas, A. L., Yiannakouris, N., Papoutsakis, C., Passos, M., & Klimis-Zacas, D. (2004). Disordered eating attitudes: an emerging health problem among Mediterranean adolescents. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 9(2), 126-133.
Copyright information
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (Creative Commons Attribution License 3.0 - CC BY 3.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
info@iseic.cz, www.iseic.cz, ojs.journals.cz